■这项对随机对照试验(RCT)的系统评价和荟萃分析旨在全面评估扁桃体切除术患者中消融术与谐波手术刀方法的疗效。
■PubMed,Cochrane中央控制试验登记册,Scopus,WebofScience,和谷歌学术数据库从一开始到2022年10月都进行了系统的筛选。在随机效应模型中,将结果总结为风险比(RR)或平均差/标准化平均差(MD/SMD)以及95%置信区间(CI)。
■分析了六个随机对照试验,包括461名患者(谐波手术刀=233名患者,消融术=228名患者)。总体质量评估在两个RCT中存在低偏倚风险,三个RCT中的一些偏见,和一个RCT的高偏倚风险。谐波手术刀和消融术组的平均手术时间没有显着差异(n=6个随机对照试验,MD=-7.45分钟,95%CI[-15.26,0.01],p=0.06)术中平均失血量(n=5个RCT,MD=-36.03ml,95%CI[-77.46,5.41],p=0.09),和术后出血率(n=5,RR=0.59,95%CI[0.25,1.39],p=0.23)。与谐波手术刀组相比,消融组的总体术后疼痛评分显着降低(n=5RCT,MD=0.40,95%CI[0.10,0.69],p=0.009)\“。
■在接受扁桃体切除术的患者中,谐波手术刀和消融技术具有同等的疗效。由消融术提供的术后疼痛评分的降低在临床实践中没有临床意义。需要额外的随机对照试验来巩固所提供证据的力量和质量。
■在线版本包含补充材料,可在10.1007/s12070-023-04022-7获得。
UNASSIGNED: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to comprehensively evaluate the efficacy of coblation versus harmonic scalpel methods among patients undergoing tonsillectomy.
UNASSIGNED: PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Google Scholar databases were systematically screened from inception until October 2022. The outcomes were summarized as risk ratio (RR) or mean difference/standardized mean difference (MD/SMD) with 95% confidence interval (CI) in a random-effects model.
UNASSIGNED: Six RCTs were analyzed, encompassing a sum of 461 patients (harmonic scalpel = 233 patients and coblation = 228 patients). The overall quality assessment was low risk of bias in two RCTs, some concerns of bias in three RCTs, and high risk of bias in one RCT. There was no significant difference between harmonic scalpel and coblation groups regarding the mean operative time (n = 6 RCTs, MD=-7.45 min, 95% CI [-15.26, 0.01], p = 0.06) mean intraoperative blood loss (n = 5 RCTs, MD=-36.03 ml, 95% CI [-77.46, 5.41], p = 0.09), and rate of postoperative hemorrhage (n = 5 RCTs, RR = 0.59, 95% CI [0.25, 1.39], p = 0.23). The overall postoperative pain score was significantly reduced in favor of the coblation group compared with the harmonic scalpel group (n = 5 RCTs, MD = 0.40, 95% CI [0.10, 0.69], p = 0.009)\".
UNASSIGNED: The harmonic scalpel and coblation techniques share equal efficacy among patients undergoing tonsillectomy. The reduction in postoperative pain score provided by the coblation method is not clinically meaningful in clinical practice. Additional RCTs are needed to consolidate the power and quality of the presented evidence.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s12070-023-04022-7.